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Kutikov A , Smaldone MC , Egleston BL , Manley BJ , Canter DJ , Simhan J , Boorjian SA , Viterbo R , Chen DYT , Greenberg RE , Uzzo RG
Anatomic Features of Enhancing Renal Masses Predict Malignant and High-Grade Pathology: A Preoperative Nomogram Using the RENAL Nephrometry Score
European Urology. 2011 Aug;60(2) :241-248
PMID: ISI:000291977400018    PMCID: PMC3124570   
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Abstract
Background: Counseling patients with enhancing renal mass currently occurs in the context of significant uncertainty regarding tumor pathology. Objective: We evaluated whether radiographic features of renal masses could predict tumor pathology and developed a comprehensive nomogram to quantitate the likelihood of malignancy and high-grade pathology based on these features. Design, setting, and participants: We retrospectively queried Fox Chase Cancer Center's prospectively maintained database for consecutive renal masses where a Nephrometry score was available. Intervention: All patients in the cohort underwent either partial or radical nephrectomy. Measurements: The individual components of Nephrometry were compared with histology and grade of resected tumors. We used multiple logistic regression to develop nomograms predicting the malignancy of tumors and likelihood of high-grade disease among malignant tumors. Results and limitations: Nephrometry score was available for 525 of 1750 renal masses. Nephrometry score correlated with both tumor grade (p < 0.0001) and histology (p < 0.0001), such that small endophytic nonhilar tumors were more likely to represent benign pathology. Conversely, large interpolar and hilar tumors more often represented high-grade cancers. The resulting nomogram from these data offers a useful tool for the preoperative prediction of tumor histology (area under the curve [AUC]: 0.76) and grade (AUC: 0.73). The model was subjected toout-of-sample cross-validation; however, lack of external validation is a limitation of the study. Conclusions: The current study is the first to objectify the relationship between tumor anatomy and pathology. Using the Nephrometry score, we developed a tool to quantitate the preoperative likelihood of malignant and high-grade pathology of an enhancing renal mass. (C) 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Notes
Kutikov, Alexander Smaldone, Marc C. Egleston, Brian L. Manley, Brandon J. Canter, Daniel J. Simhan, Jay Boorjian, Stephen A. Viterbo, Rosalia Chen, David Y. T. Greenberg, Richard E. Uzzo, Robert G. National Cancer Institute [P30 CA006927]; Department of Defense This publication was supported in part by grant number P30 CA006927 from the National Cancer Institute and by the Department of Defense, Physician Research Training Award (AK). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute, the National Institutes of Health, or the Department of Defense. 33 Elsevier science bv; po box 211, 1000 ae amsterdam, netherlands 781zr